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Reliability of noninvasive hemodynamic assessment with Doppler echocardiography

comparison with the invasive evaluation

de Scordilli, Marcoa; Pinamonti, Brunob; Albani, Stefanob; Gregorio, Caterinac,*; Barbati, Giuliaa; Daneluzzi, Chiarab; Korcova, Renatab; Perkan, Andreab; Fabris, Enricob; Geri, Pietrod; Biolo, Marcod; Lo Giudice, Francescob,†; Confalonieri, Marcod; Sinagra, Gianfrancob

Journal of Cardiovascular Medicine: October 2019 - Volume 20 - Issue 10 - p 682–690
doi: 10.2459/JCM.0000000000000841
Research articles: Imaging
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Aims The study aimed at evaluating the reliability and reproducibility of various noninvasive echocardiographic techniques for the estimation of the main hemodynamic parameters in clinical practice.

Methods A total of 84 patients with a generic indication of right heart catheterization (RHC) executed a transthoracic echocardiography shortly before or after the RHC. All the parameters necessary for a noninvasive hemodynamic evaluation of right atrial pressure, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure, pulmonary vascular resistance and cardiac output were acquired and the agreement with the invasive measures was evaluated by a Bland–Altman analysis.

Results Noninvasive evaluation of right atrial pressure showed a moderate and low correlation with RHC using inferior vena cava parameters (r = 0.517) and tricuspid E/E′ ratio (sensitivity 0.23, specificity 0.72), respectively. PAPs estimation from the tricuspid regurgitation peak velocity had a good correlation (r = 0.836) and feasibility (82.1%), as well as PAPm from tricuspid regurgitation mean gradient (r = 0.78, applicability 72.6%) and from pulmonary acceleration time (sensitivity 0.85, specificity 0.5, applicability 92.9%). Pulmonary capillary wedge pressure multiparametric evaluation, as suggested by the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations, showed a good correlation (sensitivity 0.96, specificity 0.59). The noninvasive evaluation of pulmonary vascular resistance and cardiac output did not prove to be clinically accurate.

Conclusion Various hemodynamic parameters can be adequately estimated with noninvasive methods. In particular, a multiparametric approach for the evaluation of left ventricle filling pressures is advisable and the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations are reliable even in a heterogeneous population with a significant quota of precapillary pulmonary hypertension.

aDepartment of Medical Science, Surgery and Health (DCSMCS), University of Trieste, Ospedale di Cattinara

bCardiovascular Department ASUITS and Postgraduate School in Cardiovascular Sciences, University of Trieste, Ospedale di Cattinara – Polo Cardiologico

cDepartment of Economics, Business, Mathematics and Statistics, University of Trieste

dDepartment of Pneumology and Respiratory Intermediate Care Unit, ASUITS, Ospedale di Cattinara, Trieste, Italy

Correspondence to Marco de Scordilli, Department of Medical Science, Surgery and Health (DCSMCS), University of Trieste, Ospedale di Cattinara, Via Rossetti, 51, 34141 Trieste, Italy Tel: +39 3497644274; e-mail: marco.descordilli@gmail.com

Received 14 March, 2019

Revised 4 July, 2019

Accepted 7 July, 2019

© 2019 Italian Federation of Cardiology. All rights reserved.